Chapter 20

Question 0

​1.​A risk factor for cardiovascular disease that may be modified by dietary or other lifestyle changes includes

a. male gender.
b. family history.
c. race and heredity.
d. physical inactivity.

Answer 0

ANS:​D
A modifiable risk factors for cardiovascular disease includes physical inactivity. Male gender, family history, and race and heredity are all risk factors, but they cannot be modified by dietary or other lifestyle changes.

Question 1

​2.​Atherosclerosis refers to

a. chest pain that often radiates down the left arm.
b. development of lesions in the endothelium of arteries.
c. high levels of low-density lipoprotein (LDL) cholesterol in the blood.
d. complete blockage of a coronary artery, also known as a heart attack.

Answer 1

ANS:​B
Atherosclerosis is development of lesions in the endothelium of arteries. Chest pain that radiates down the left arm may be angina pectoris or could be a myocardial infarction (heart attack). A high level of LDL cholesterol is one of the factors that contributes to atherosclerosis. Complete blockage of a coronary artery or heart attack may be caused by atherosclerosis.

Question 2

​3.​If a patient has a thrombosis in a cerebral artery, he or she would experience

a. a stroke.
b. a migraine headache.
c. a heart attack.
d. angina pectoris.

Answer 2

ANS:​A
If a patient has a thrombosis in a cerebral artery, he or she would experience a stroke or cerebrovascular accident (CVA). A migraine headache is thought to be caused by dilation of blood vessels in the brain. Heart attacks are caused by a thrombosis in a coronary artery that completely blocks the artery. Angina pectoris is caused by a thrombus in the coronary artery that causes only partial occlusion of the blood vessel.

Question 3

​4.​Peripheral vascular disease occurs when atherosclerosis causes blockages in the

a. cerebral, vertebral, and carotid arteries.
b. hepatic and renal arteries.
c. pulmonary and myocardial arteries.
d. abdominal aorta, iliac arteries, and femoral arteries.

Answer 3

ANS:​D
Peripheral vascular disease occurs when atherosclerosis causes blockages in the abdominal aorta, iliac arteries, and femoral arteries. Blockage of cerebral arteries causes stroke. Blockage of myocardial arteries causes heart attack. Blockage of the other arteries is less common.

Question 4

​5.​Cholesterol travels in the bloodstream in

a. bile.
b. plaques.
c. lipoproteins.
d. blood cells.

Answer 4

ANS:​C
Cholesterol travels in the bloodstream in lipoproteins that contain lipids and proteins. Bile salts are made from cholesterol. Cholesterol forms plaques when it is deposited in blood vessels. Blood cells carry oxygen (red blood cells) or are part of the immune system (white cells) but do not carry cholesterol.

Question 5

​6.​Goals of therapy to reduce risk of cardiovascular disease focus on lowering levels of

a. triglycerides.
b. low-density lipoprotein (LDL) cholesterol.
c. high-density lipoprotein (HDL) cholesterol.
d. very low-density lipoprotein (VLDL) cholesterol.

Answer 5

ANS:​B
Primary goals of therapy to reduce risk of cardiovascular disease focus on lowering blood levels of LDL cholesterol. Lowering serum triglyceride levels and VLDL cholesterol levels and increasing HDL cholesterol levels also decreases cardiovascular risk, but are not the main focus.

Question 6

​7.​A desirable serum total cholesterol level is <_____ mg/dL.

a. 100
b. 130
c. 160
d. 200

Answer 6

ANS:​D

A desirable serum total cholesterol level is <160 mg/dL.

Question 7

​8.​A serum triglyceride level of 175 mg/dL is considered

a. normal.
b. borderline high.
c. high.
d. very high.

Answer 7

ANS:​B
A serum triglyceride level of 175 mg/dL is considered borderline high. Serum triglyceride level 500 mg/dL is considered very high.

Question 8

​9.​Risk of cardiovascular disease is inversely associated with levels of

a. total cholesterol.
b. low-density lipoprotein (LDL) cholesterol.
c. high-density lipoprotein (HDL) cholesterol.
d. very low-density lipoprotein (VLDL) cholesterol.

Answer 8

ANS:​C
Risk of cardiovascular disease is inversely associated with levels of HDL cholesterol. Cardiovascular risk is positively associated with levels of total cholesterol, LDL cholesterol, and VLDL cholesterol.

Question 9

​10.​Therapeutic lifestyle changes (TLCs) recommended to reduce the risk of coronary heart disease include reduced intake of _____ fat(s).

a. total
b. saturated
c. monounsaturated
d. polyunsaturated

Answer 9

ANS:​B
TLCs recommended to reduce the risk of coronary heart disease include reduced intake of saturated fats. Intake of total fat does not appear to affect LDL cholesterol level. Substitution of monounsaturated or polyunsaturated fats for saturated fats can help decrease LDL cholesterol levels; polyunsaturated fats may also decrease HDL cholesterol levels and so should be moderated.

Question 10

​11.​Each 1% increase in dietary kcal from saturated fats is associated with an increase in LDL cholesterol level of about

a. 2%.
b. 4%.
c. 5%.
d. 7%.

Answer 10

ANS:​A
Each 1% increase in dietary kcal from saturated fats is associated with an increase in LDL cholesterol level of about 2%.

Question 11

​12.​Most dietary fat should be in the form of

a. fat substitutes.
b. fat-soluble vitamins.
c. polyunsaturated fat.
d. monounsaturated fat.

Answer 11

ANS:​D
Most dietary fat (up to 20% of energy intake) should be in the form of monounsaturated fat. Polyunsaturated fat should contribute up to 10% of energy intake. Fat substitutes and fat-soluble vitamins do not provide dietary fat.

Question 12

​13.​The type of fiber that is most effective in helping to decrease LDL cholesterol is

a. dietary fiber.
b. soluble fiber.
c. insoluble fiber.
d. resistant starch.

Answer 12

ANS:​B
Addition of 5 to 10 g soluble fiber daily can decrease LDL cholesterol by 5%. Insoluble fiber and resistant starch do not have this benefit. Dietary fiber may be beneficial because it may include soluble fiber.

Question 13

​14.​Most people experience reductions in LDL cholesterol if they limit dietary cholesterol intake to less than _____ mg/day.

a. 100
b. 200
c. 300
d. 400

Answer 13

ANS:​B

Most people experience reductions in LDL cholesterol if they limit dietary cholesterol intake to less than 200 mg/day.

Question 14

​15.​A dietary change that is likely to have a significant effect on reducing the risk of coronary heart disease is

a. snacking on tortilla chips instead of peanuts.
b. drinking decaffeinated coffee instead of regular coffee.
c. switching from cornflakes to oatmeal for breakfast.
d. choosing a fast-food fish sandwich instead of a hamburger.

Answer 14

ANS:​C
Switching from cornflakes to oatmeal for breakfast is likely to have a significant effect on reducing risk of coronary heart disease because this change will increase intake of soluble fiber. Snacking on tortilla chips instead of peanuts would increase intake of polyunsaturated fat and decrease intake of monounsaturated fat, which would probably not affect LDL cholesterol levels and may decrease HDL cholesterol levels. Drinking decaffeinated coffee instead of regular coffee is not beneficial for most people. Choosing a fast-food fish sandwich instead of a hamburger could result in increased total fat intake because the fish is fried; intake of saturated and unsaturated fats will depend on the fat used for frying and any sauces added.

Question 15

​16.​The first step in therapy to reduce the risk for coronary heart disease is

a. therapeutic lifestyle change.
b. stress reduction.
c. use of LDL-lowering medications.
d. use of anti-thrombotic medications.

Answer 15

ANS:​A
The first step in therapy to reduce the risk for coronary heart disease is therapeutic lifestyle change (TLC), including diet and physical activity. Cholesterol-lowering medications should be added to TLC if needed to achieve further reductions in LDL-C. Antithrombotic medications are not used routinely (they may sometimes be used to reduce risk of blood clots). Stress reduction can help decrease cardiac risk, but is not the first step.

Question 16

​17.​Drug therapy should be initiated at the same time as therapeutic lifestyle change (TLC) only in patients who

a. have severe hypercholesterolemia.
b. are not using other prescription medications.
c. have a family history of coronary heart disease.
d. are unwilling to implement therapeutic lifestyle change.

Answer 16

ANS:​A
Drug therapy should only be initiated at the same as TLC in patients with severe hypercholesterolemia, who are unlikely to be able to decrease LDL cholesterol to desirable levels using TLC alone. The need for cholesterol-lowering medications is not related to use of other medications. Family history is one of many risk factors for coronary heart disease and does not necessitate immediate drug therapy.

Question 17

​18.​Primary or essential hypertension is caused by

a. unknown factors.
b. sedentary lifestyle.
c. excess sodium intake.
d. being overweight or obese.

Answer 17

ANS:​A
Primary or essential hypertension is caused by unknown factors. Sedentary lifestyle, excess sodium intake, and being overweight or obese all contribute to hypertension and are all factors that can be modified to decrease blood pressure.

Question 18

​19.​If a patient’s blood pressure is 152/94 mm Hg, they have

a. normal blood pressure.
b. prehypertension.
c. stage 1 hypertension.
d. stage 2 hypertension.

Answer 18

ANS:​C
Blood pressure of 152/94 mm Hg is considered stage 1 hypertension. Stage 1 hypertension is systolic blood pressure 140 to 159 mm Hg or diastolic blood pressure 90 to 99 mm Hg. Stage 2 hypertension is systolic blood pressure >160 mm Hg or diastolic blood pressure 110 mm Hg. Prehypertension is systolic blood pressure 120 to 139 mm Hg or diastolic blood pressure 80 to 89 mm Hg. Normal blood pressure is systolic blood pressure <80 mm Hg.

Question 19

​20.​Before drug therapy is considered, patients with mild to moderate hypertension should attempt to lower their blood pressure using lifestyle modifications for

a. 3 to 6 weeks.
b. 6 to 8 weeks.
c. 3 to 6 months.
d. 6 to 8 months.

Answer 19

ANS:​C
Patients with mild to moderate hypertension should attempt to lower their blood pressure using lifestyle modifications for 3 to 6 months before drug therapy is considered.

Question 20

​21.​Risk of hypertension may be decreased by increasing intake of foods that are good sources of

a. iron, zinc, and copper.
b. selenium, chromium, and iodine.
c. sodium, chloride, and bicarbonate.
d. potassium, magnesium, and calcium.

Answer 20

ANS:​D
Increasing intake of foods rich in potassium, magnesium, and calcium can help decrease risk of hypertension. Intakes of iron, zinc, copper, selenium, chromium, iodine, chloride, and bicarbonate do not affect blood pressure. Increasing intake of foods high in sodium will generally increase blood pressure.

Question 21

​22.​If a middle-aged man has high blood pressure, has a sedentary lifestyle, is about 30 pounds overweight, eats mostly processed food, and drinks two alcoholic beverages most days, the most effective way for him to lower his blood pressure is to

a. reduce his sodium intake.
b. achieve and maintain a healthy weight.
c. participate in aerobic exercise every day.
d. abstain from drinking alcoholic beverages.

Answer 21

ANS:​B
The most effective way for him to lower his high blood pressure would be to achieve and maintain a healthy weight. Reducing sodium intake, participating in aerobic exercise every day, and abstaining from drinking alcoholic beverages would also help lower his blood pressure, but to a lesser extent.

Question 22

​23.​In America, most dietary sodium comes from

a. salt added at the table.
b. sodium naturally present in foods.
c. salt added to foods during cooking.
d. salt added to foods during processing.

Answer 22

ANS:​D
In America, most dietary sodium comes from salt added to foods during processing. Processed foods often contain more sodium than when foods are prepared from scratch at home, plus intakes of processed foods are high. Therefore salt added at the table and salt added to foods during cooking contribute less to overall salt intake. Most natural foods contain relatively little sodium.

Question 23

​24.​The main purpose of nutrition therapy for patients who have just experienced a myocardial infarction is to decrease

a. blood pressure.
b. the risk of blood clotting.
c. LDL cholesterol levels.
d. the workload of the heart.

Answer 23

ANS:​D
Immediately after a myocardial infarction, nutrition therapy is designed to decrease the workload of the heart. Long-term nutrition therapy may focus on decreasing LDL cholesterol levels and blood pressure. Risk of blood clotting is controlled using medications rather than diet.

Question 24

​25.​One or 2 days after a myocardial infarction, patients are likely to best tolerate

a. a clear liquid diet.
b. mostly cold foods.
c. small, frequent meals.
d. three moderate meals a day.

Answer 24

ANS:​C
One or 2 days after a myocardial infarction, patients are likely to best tolerate small, frequent meals. A clear liquid diet is only used during the first 24 hours after a myocardial infarction. There is no reason to eat mostly cold foods. Three moderate meals a day would place a greater oxygen demand on the heart than smaller, more frequent meals.

Question 25

​26.​For patients with congestive heart failure, nutrition therapy focuses on

a. restriction of dietary sodium intake.
b. abstinence from alcoholic beverages.
c. achievement and maintenance of a healthy weight.
d. restriction of dietary saturated fats and cholesterol.

Answer 25

ANS:​A
Nutrition therapy for patients with congestive heart failure focuses on restriction of dietary sodium intake to reduce extracellular fluid. Abstinence from alcoholic beverages is not a focus of treatment. Dietary restrictions to lose weight or reduce intake of saturated fat and cholesterol may be harmful because patients often have increased energy needs and poor appetite. Restrictions in energy intake may contribute to cardiac cachexia.

Question 26

​27.​If patients with congestive heart failure experience cardiac cachexia, it is important to make sure that they have adequate intakes of

a. vitamin C and iron.
b. energy and protein.
c. essential amino acids and essential fatty acids.
d. dietary fiber and monounsaturated fats.

Answer 26

ANS:​B
It is important to make sure that patients with cardiac cachexia have adequate intakes of energy and protein to prevent further catabolism. If intakes of energy and protein are adequate, intakes of other nutrients are also likely to be adequate.

Question 27

​28.​The best time to begin to adopt heart-healthy eating habits is during

a. childhood to establish a lifelong healthy lifestyle.
b. adolescence because most teens have poor eating habits.
c. young adulthood once development is complete.
d. middle adulthood when coronary heart disease begins to develop.

Answer 27

ANS:​A
The best time to begin to adopt heart-healthy eating habits is during childhood when lifelong eating habits are being established. It is beneficial to begin healthy eating habits at any age, but it is not necessary to wait until poor habits have developed or until coronary heart disease begins to develop. Severe food restrictions should be avoided in children and adolescents to ensure adequate kcal and nutrient intakes for growth and development. But children and adolescents can still learn to choose foods and develop habits that will maintain optimal heart health throughout their life.

Question 28

​29.​Compared with a comparable regular food, a food product that claims to be “light” must contain ____% fewer kcals or _____% less fat.

a. 25; 75
b. 33; 33
c. 33; 50
d. 50; 33

Answer 28

ANS:​C

A “light” version of a regular food must have 33% fewer kcal or 50% less fat than the regular product.

Question 29

​30.​Malnourished patients with chronic obstructive pulmonary disease (COPD) require protein intakes that are

a. relatively low to reduce the metabolic burden.
b. the same as healthy patients.
c. relatively high to increase ventilatory drive.
d. higher than can be met by oral intake.

Answer 29

ANS:​C
Malnourished patients with COPD have relatively high protein requirements to help increase ventilatory drive and preserve muscle mass. Low protein intakes will contribute to malnutrition. Protein needs are higher than for healthy patients, but can be achieved using a well-planned diet.

Question 30

​31.​The respiratory quotient may be decreased by increasing the proportion of energy intake from

a. fat.
b. protein.
c. carbohydrates.
d. fat and carbohydrates.

Answer 30

ANS:​A
Respiratory quotient is lower when the proportion of energy intake from fat is higher. The respiratory quotient is the amount of carbon dioxide produced compared to the amount of oxygen used. Respiratory quotient is high for carbohydrate and low for fat.

Question 31

​32.​Most patients with acute respiratory failure require enteral or parenteral nutrition support because they

a. require mechanical ventilation.
b. often have difficulty swallowing.
c. are too tired to consume an adequate diet.
d. are unable to coordinate eating and breathing.

Answer 31

ANS:​A
Most patients with acute respiratory failure require enteral or parenteral nutrition support because they require mechanical ventilation and cannot eat normally with a breathing tube in place.

Question 32

​33.​When using parenteral nutrition support for patients with acute respiratory failure, it is important to avoid use of high glucose concentrations because

a. glucose tolerance is often impaired.
b. they may cause hypersecretion of insulin.
c. they result in excess carbon dioxide production.
d. they may lead to development of diabetes mellitus.

Answer 32

ANS:​C
Parenteral nutrition support for patients with acute respiratory failure should not use high glucose concentrations because they result in excess carbon dioxide production. Lipids should be used to provide a significant proportion of nonprotein kcals (1 to 2 g lipid per kg body weight). Glucose tolerance is not affected by respiratory failure. Infusion of high concentrations of glucose does not cause hypersecretion of insulin or lead to development of diabetes mellitus.